Improving Monitoring of Patients Receiving Case Management

Improved Targeting of Admission Avoidance Interventions in Older People With Long-term Conditions:An Observational,Longitudinal Study Exploring the Feasibility of Measures of Strength as a Monitoring Aid in Patients Receiving Case Management

The UK population is ageing and the likelihood of having a long term health condition increases with age. Three out of every five people over 60 in the UK have a long term condition. Ageing and having a long term condition increases the chance of having difficulty being independent and carrying out day to day activities. In recent years the NHS has made a greater effort to prevent these difficulties in patients with long term conditions.

One approach to help patients with long term conditions is case management, where by (usually) a community matron visits patients at home, looking for early warning signs of any worsening of their condition and arranging care and treatment. But the current way this is done varies across the country and hospital admissions are still rising. In order to give the right care at the right time, effective monitoring is needed to help the community matron detect and act on changes in the patient's condition.

Loss of muscle strength in old age is linked to a poor health, but it is not known whether simple measures of muscle strength could be used to detect and predict declines in health in the short to medium term to help maintain independence and prevent an accident or hospital admission.

The aim of this study is to look at whether monitoring muscle strength in case managed patients is practical, acceptable and useful in detecting when a patient's condition worsens. Each patient will be visited by the researcher in their home twice in the first week, then once every two weeks, for another 5 weeks, to carry out three simple measures of grip and respiratory strength, and complete questionnaires about their health and ability to carry out day to day activities. Each visit will last about 20 to 30 minutes. A small group of clinicians will be asked about their views of the strength measures. Database analysis will allow descriptive data on the patient group to be gathered and analysed.

Study Overview

• Status: Completed
• Conditions: Hypertension; Diabetes; Chronic Obstructive Pulmonary Disease; Coronary Heart Disease; Multiple Conditions

• Study Type: Observational
• Enrollment (Actual): 114

Contacts and Locations

Study Locations

• United Kingdom
  • Portsmouth, United Kingdom, PO4 8LD
    • Solent NHS Trust
  • Southampton, United Kingdom, PO13 0FH
    • Southern Health NHS Foundation Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients receiving cmmunity health case management.

Description

Inclusion Criteria:

• Patients aged 65 years or over receiving health case management in the community.

Exclusion Criteria:

1. Enrolled in any other research study

2. Preclude consent:

   • Significant cognitive impairment resulting in lack of capacity to consent. b. Unable to communicate without significant aids e.g. Non-English speaking.

3. Preclude participation/ collection of data

   • Significant emotional distress or psychotic illness active within the last 6 months.
   • Receiving end of life care.
   • Current illness that would preclude data collection.
   • Upper limb pathology that would limit participation e.g. bone fracture within the previous 6 months.
   • Identified as high risk patients with regards to lone working safety by their case manager.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Case managed patients; Patients aged 65 years and over receiving community case management.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Grip strength	To assess reliability of measure over a one week period and the stability of the measure over 13 weeks, in this patient group, as well as acceptability.	13 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Peak expiratory flow	To measure reliability over one week and stability over 13 weeks in this patient group, as well as acceptability.	13 weeks
Peak inspiratory flow	To assess reliability over one week, and stability over 13 weeks in this patient group, as well as acceptability.	13 weeks
Sickness behaviour scale	To explore the relationship between sickness behaviour and measures of strength.	13 weeks

Collaborators and Investigators

• Sponsor: University of Southampton
• Investigators: Principal Investigator: Nicola Barnes, MPharm, University of Southampton

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (Actual): December 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: May 10, 2012
• First Submitted That Met QC Criteria: May 11, 2012
• First Posted (Estimate): May 14, 2012

Study Record Updates

• Last Update Posted (Estimate): February 19, 2014
• Last Update Submitted That Met QC Criteria: February 16, 2014
• Last Verified: February 1, 2014

More Information

Terms related to this study

• Keywords: case management; long term conditions; aged sixty five and over
• Additional Relevant MeSH Terms: Pathologic Processes; Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Lung Diseases; Heart Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive; Disease
• Other Study ID Numbers: 8550; 1409-ERGO (Other Identifier: University of Southampton)